Revitalising the firm for the 21st century

When I graduated in 1995, hospital medicine in the UK was organised around a "firm"-a team of consultants, registrars, senior house officers, and house officers who knew their patients, and each other.The firm model had flaws: standards varied, hours were long, and the culture could be paternalistic.Yet it delivered something we have since lost: continuity, tacit knowledge, and shared accountability.The European Working Time Directive (EWTD), introduced in the UK in 1998, and rota redesign dismantled this structure.Studies of the EWTD highlight mixed effects: there were some improvements in work-life balance, but also reductions in continuity, team cohesion, and training quality.The number of handovers multiplied, and responsibility for the patient journey often became unclear.